Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036134900 | IL |
N | 111NI0900X | Internist | 036134900 | IL |
N | 207R00000X | Internist | 2011017889 | MO |
N | 111NI0900X | Internist | 2011017889 | MO |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036134900 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | 036134900 | IL |
NPI | 1730474685 |
---|---|
Provider Name | Dr. Anjan Tibrewala |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 25/07/2019 |